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m = i• i• M MW M I• i• I• �� <br /> Advanced CHAIN 9FCUSTODY RECORD <br /> Date 3 © Page A- of <br /> GeoEnvironmentai, Inc. <br /> 4005 North Wilson Way-Stockton,California-95205 (209)467-1000-Fax(209)467-1118 <br /> Client C&L�) Pr°jenl' tLatA <br /> Tests Required <br /> Phone Number <br /> Sam I . (Signature) Invoice <br /> AGE <br /> Project Nameblzt Client <br /> i <br /> Sample Location Sample TypeSolid No of Notes <br /> Number Description Date Time Water Air Conts <br /> Comp Grab — <br /> � 141 <br /> L23:0-01 _ - 61897- <br /> 1 --m 3 a <br /> 61890 <br /> �-o � � �. _ 61900 <br /> 61 (In <br /> 1?4W ,06-0 , <br /> e nq sdJft-- Flacefyod by J5tgn&1U1QJr <br /> Relinquis ed by (Signa ure) Received by (Signature) 1r r [Jake(i ince <br /> Relinquished y (Signature) Received by Nobde laboratory lot field analysis (Signature) r"� Dateffime <br /> 5 + <br /> Dispatched by (Signature) Dale/Tlme Recai7lot to otatory by Date/Time <br /> Method of Shipment taborat77"V,4-4- <br /> A 0.o7 <br /> special Instructions I hereby au oriz the per rmance of the above Indicated work <br />